SELF EMPLOYED - POLICIES AND PROCEDURES
Common Questions About Self-Insurance
What is self-insurance?
“Benefit Management Services of Ohio, Inc. provides the highest quality service in the industry and their experienced friendly staff are great to work with.”
–Diane Brookover, Secretary/Treasurer
Cardinal Rubber Company
What are the requirements for an employer to become self-insured?
Five years of financial statements, audited in accordance with generally accepted accounting principles, are required to provide full financial disclosure of the employer.
What are the costs to the employer?
Also, new self-insuring employers must contribute to the Self-Insured Guaranty Fund, which is used to pay claims of self-insuring employers who have defaulted. The guaranty fund assessment is 6 percent of base-rated premium payments one year prior to application. This is assessed once a year for three years.
In addition, self-insuring employers must reimburse any Disabled Worker Relief Fund payments, dollar for dollar, on a semiannual basis regardless of the date of injury. (see reverse side for additional information on costs to employers).
How does an employer apply for self-insurance?
Additional costs to the employer
These costs are in addition to the BWC assessment fees, mandatory contributions to the Self-Insured Guaranty Fund and other costs mentioned on the front of this sheet.
To apply for self-insurance, the employer must complete and submit the following BWC forms:
The following supporting-documentation must also be supported for review:
1. The self-insuring (SI) employer must maintain an office in the state of Ohio and have one or more employees knowledgeable and capable of administering a workers' compensation program.
2. A copy of the employer’s “Certificate of Employer’s Right to Pay Compensation Direct” must be posted at each work site with the name, title and location of the person responsible for handling its workers' compensation program.
3. Ultimate responsibility for the claim will reside with the self-insuring employer. The SI employer must:
4. The employer may retain a Third Party Administrator (TPA) or individual to assist in the administration of workers' compensation claims.
5. The employer must furnish or make arrangements for reasonable medical services during working hours in accordance with BWC rules.
6. Under OAC 4123-19-03 (L)(10), the employer must inform an injured worker (IW) and BWC in writing, within thirty days from the date of notification of injury or occurrence, of the conditions it has recognized as related to the injury or occupational disease and what, if any, it refuses to recognize.
7. All medical bills must be addressed within 30 days of the receipt of the bill. The employer may pay, deny, or withhold payment pending further information, but must respond within 30 days.
8. The self-insuring employer has the authority to terminate temporary total compensation in accordance with ORC 4123.56(A). Disputed issues must be sent to the IC for a determination.
10. If a request has been denied by an SI employer, i.e. medical bills, treatment, compensation, etc. The IW must file a motion requesting the denied items be approved and submit evidence supporting the motion.
11. When the IC rules on a claim the SI employers must pay compensation upon receipt of the order by the DHO within 21 days of receipt of the order.
12. SI employers are required to submit proof of payment of bills or compensation upon request by BWC.
13. SI employers are required to respond to C161, request for authorization, within 10 days of receipt.
14. SI employers are required to respond to C23, request for change of physician, within 7 days of receipt.